據《衛報》報道,在一批機構高調取消活動之后,面對來自公眾和科學界的壓力,英國政府將從下周末開始取消大型集會。
在政府宣布該決定之前,從英格蘭足球超級聯賽到英國女王,都接二連三地取消了比賽和官方活動,盡管根據政府公布的政策,取消活動無助于阻止感染,反而會嚴重干擾公共生活。
知名科學家和政界人士也紛紛批評鮑里斯·約翰遜政府公布的新型冠狀病毒疫情防控舉措。英國政府采取的策略與歐洲多數政府的防控措施截然不同,而且盡管政府宣布取消大型集會,但原定政策將繼續有效。
科學家和政界人士的反對意見主要集中在獲得對病毒的“群體免疫力”這條政策。該政策意味著讓至少4000萬英國人感染病毒,最終使全社會對這種疾病形成長期抵抗力。
英國政府首席科學顧問帕特里克·瓦蘭斯上周五參加BBC廣播四臺《今日》欄目時表示:“我們的目的是盡量降低和壓平峰值,而不是完全抑制高峰期到來。而且由于絕大多數人的癥狀較輕,能夠獲得一定程度的群體免疫力,從而使更多人對這種疾病免疫,就能減少病毒傳播。”
英國政府稱,需要約六成人口感染病毒,才能獲得群體免疫。到那時,傳播率會下降,足以保護剩余40%的英國人,使他們免于感染病毒。但這種策略還有重要的一點,即盡量控制被感染群體。在理想情況下,政府希望只有可能出現輕度癥狀的人群感染病毒。(英國政府此前曾經表示,在最糟糕的情況下,最終可能有80%的人口感染病毒,高于德國政府估計的70%。)
英國的疫情防控方法意味著在盡量降低死亡率的同時,國內許多健康人將不得不染上這種疾病。這個策略與其他許多國家努力防止人們感染的做法截然不同。
英國政府的方法基于一種假設,即COVID-19會像流感一樣,成為一種重復出現的季節性病毒,而且只要感染過這種病毒就不會再次感染。如果確實如此(存在非常大的不確定性),從長遠的角度來看,通常有兩種方式可以防控病毒。第一種是通過疫苗,如果沒有疫苗,第二種方式是讓足夠多的人感染病毒,在康復后產生免疫力避免重復感染,從而降低病毒的流行性,并減少易感染人群面臨的風險。
但正如多位科學專家所說,問題在于這種方法依舊存在巨大的風險。
愛丁堡大學全球公共衛生項目主任德維·施利達在推文中寫道:“我今天跟其他學術界人士、科學記者、私營公司和政府人員交流過,但我依舊很難理解政府的做法。政府似乎照搬了應對流感的策略。但COVID-19可不是流感,它比流感更難對付,造成的健康后果非常嚴重。”
同時,完全隔離易感染人群可能并不現實,甚至無法確定哪些人是易感染人群。實現群體免疫有很大難度;例如,對于麻疹,只能通過非常高的疫苗接種率才能維持群體免疫。
瓦蘭斯、首席醫學官克里斯·惠蒂和英國首相約翰遜在上周四晚上出席了新聞發布會。英國政府在發布會上宣布,英國將進入病毒防控的“延緩”階段,通過壓平病例曲線,將新型冠狀病毒的高峰期延遲到溫暖月份,從而減輕醫療系統的壓力。呼吸道病毒在溫暖月份的流行性通常較弱。
雖然政府的防控措施要求有輕度咳嗽和流感癥狀的人群留在家中,但卻未采用歐洲多數國家和北美國家逐步采取的措施,如封閉大中學校等。
政府在上周四宣布,可能在未來某個時間點執行這些更嚴格的措施,但在沒有絕對必要之前這樣做還為時尚早,會干擾人們的日常生活。這些措施會讓人們對于遵守隔離限制產生疲勞,而且根據英國政府提供的數據,當感染人數即將達到高峰時,人們反而會因為疲勞而忽視這些限制措施。
英國的疫情防控策略嚴重依賴數學模擬和一個綽號“助推小組”的政府行為洞察團隊。該團隊利用心理學理論,“助推”人們做出某種行為,如繳稅或生病時留在家中等。
但英國政府公布的新措施沒有其他國家那么嚴格,而且這些措施強調群體免疫,因此遭到了知名病毒學家和流行病學家以及保守黨在內的政界人士的強烈批評。
在BBC電視臺的《新聞之夜》欄目中,英國前衛生大臣和外交事務大臣、保守黨議員杰里米·亨特稱政府不取消大型集會的決定“令人意外和擔憂”,他表示根據當前的預測,英國的感染率會在約四周內達到意大利目前的水平,因此英國應該采取更極端的措施做好準備。
與此同時,前保守黨內閣大臣羅里·斯圖爾特在接受CNN主持人克里斯汀·阿曼普采訪時形容政府的決定是“非常反常的”策略,他表示英國政府的做法會帶來病毒在全世界傳播的風險,而且低估了病毒對本國衛生體系的影響。
斯圖爾特說:“英國試圖遵循群體免疫理論防控病毒。換言之,他們認為戰勝這種病毒是不可能的,所以最終不得不放任它在民眾當中傳播。”
“這是非常非常重要的選擇。但這根本不是科學選擇,而是政治上的決定。他們判斷人們準備容忍哪些限制,判斷人們準備接受學校關閉多久,這些都是經濟上的判斷。”
斯圖爾特補充說,他認為政府的判斷是錯誤的,因為政府決策過程不透明,而且“如果公眾了解到政府這種觀點隱含的意思是,他們寧愿讓一些人早死來阻止之后更多人的死亡,這時候人們會變得非常焦慮。”
杜克大學全球健康政策影響中心主任加文·亞梅發推文稱:“真是令人難以理解。瓦蘭斯怎么會知道新型冠狀病毒會變成一種季節性的、地方性流行病毒呢?瓦蘭斯怎么會知道最好的方法是有意識地希望大部分人感染病毒呢?這種風險極高的做法背后到底有什么證據??”
英國政府上周三公布的新疫情防控策略包括國家醫療服務體系將不再對醫院以外的患者進行病毒檢測,不再對輕癥患者進行檢測和確診。這條新政策讓政府更難確定人口達到群體免疫的具體時間,只能根據醫院確診新冠肺炎病例的死亡率向后推算。
貝爾法斯特女王大學實驗醫學中心呼吸道病毒感染專家林賽·布羅德本特指出,在新冠肺炎患者中輕癥患者應該占絕大多數。如果對輕癥病例不進行檢測,還會導致英國的死亡率統計數據失真。
她在推文中寫道:“對盡可能多的人進行檢測非常重要。韓國就是很好的例子。英國政府宣布僅對更嚴重的患者進行檢測,這會增加隔離感染患者的難度,并且產生英國死亡率很高的表象!”
根據世界衛生組織數據,截至3月16日,英國報告了1395例新型冠狀病毒病例,死亡病例35例。(財富中文網)
翻譯:劉進龍
審校:汪皓
據《衛報》報道,在一批機構高調取消活動之后,面對來自公眾和科學界的壓力,英國政府將從下周末開始取消大型集會。
在政府宣布該決定之前,從英格蘭足球超級聯賽到英國女王,都接二連三地取消了比賽和官方活動,盡管根據政府公布的政策,取消活動無助于阻止感染,反而會嚴重干擾公共生活。
知名科學家和政界人士也紛紛批評鮑里斯·約翰遜政府公布的新型冠狀病毒疫情防控舉措。英國政府采取的策略與歐洲多數政府的防控措施截然不同,而且盡管政府宣布取消大型集會,但原定政策將繼續有效。
科學家和政界人士的反對意見主要集中在獲得對病毒的“群體免疫力”這條政策。該政策意味著讓至少4000萬英國人感染病毒,最終使全社會對這種疾病形成長期抵抗力。
英國政府首席科學顧問帕特里克·瓦蘭斯上周五參加BBC廣播四臺《今日》欄目時表示:“我們的目的是盡量降低和壓平峰值,而不是完全抑制高峰期到來。而且由于絕大多數人的癥狀較輕,能夠獲得一定程度的群體免疫力,從而使更多人對這種疾病免疫,就能減少病毒傳播。”
英國政府稱,需要約六成人口感染病毒,才能獲得群體免疫。到那時,傳播率會下降,足以保護剩余40%的英國人,使他們免于感染病毒。但這種策略還有重要的一點,即盡量控制被感染群體。在理想情況下,政府希望只有可能出現輕度癥狀的人群感染病毒。(英國政府此前曾經表示,在最糟糕的情況下,最終可能有80%的人口感染病毒,高于德國政府估計的70%。)
英國的疫情防控方法意味著在盡量降低死亡率的同時,國內許多健康人將不得不染上這種疾病。這個策略與其他許多國家努力防止人們感染的做法截然不同。
英國政府的方法基于一種假設,即COVID-19會像流感一樣,成為一種重復出現的季節性病毒,而且只要感染過這種病毒就不會再次感染。如果確實如此(存在非常大的不確定性),從長遠的角度來看,通常有兩種方式可以防控病毒。第一種是通過疫苗,如果沒有疫苗,第二種方式是讓足夠多的人感染病毒,在康復后產生免疫力避免重復感染,從而降低病毒的流行性,并減少易感染人群面臨的風險。
但正如多位科學專家所說,問題在于這種方法依舊存在巨大的風險。
愛丁堡大學全球公共衛生項目主任德維·施利達在推文中寫道:“我今天跟其他學術界人士、科學記者、私營公司和政府人員交流過,但我依舊很難理解政府的做法。政府似乎照搬了應對流感的策略。但COVID-19可不是流感,它比流感更難對付,造成的健康后果非常嚴重。”
同時,完全隔離易感染人群可能并不現實,甚至無法確定哪些人是易感染人群。實現群體免疫有很大難度;例如,對于麻疹,只能通過非常高的疫苗接種率才能維持群體免疫。
瓦蘭斯、首席醫學官克里斯·惠蒂和英國首相約翰遜在上周四晚上出席了新聞發布會。英國政府在發布會上宣布,英國將進入病毒防控的“延緩”階段,通過壓平病例曲線,將新型冠狀病毒的高峰期延遲到溫暖月份,從而減輕醫療系統的壓力。呼吸道病毒在溫暖月份的流行性通常較弱。
雖然政府的防控措施要求有輕度咳嗽和流感癥狀的人群留在家中,但卻未采用歐洲多數國家和北美國家逐步采取的措施,如封閉大中學校等。
政府在上周四宣布,可能在未來某個時間點執行這些更嚴格的措施,但在沒有絕對必要之前這樣做還為時尚早,會干擾人們的日常生活。這些措施會讓人們對于遵守隔離限制產生疲勞,而且根據英國政府提供的數據,當感染人數即將達到高峰時,人們反而會因為疲勞而忽視這些限制措施。
英國的疫情防控策略嚴重依賴數學模擬和一個綽號“助推小組”的政府行為洞察團隊。該團隊利用心理學理論,“助推”人們做出某種行為,如繳稅或生病時留在家中等。
但英國政府公布的新措施沒有其他國家那么嚴格,而且這些措施強調群體免疫,因此遭到了知名病毒學家和流行病學家以及保守黨在內的政界人士的強烈批評。
在BBC電視臺的《新聞之夜》欄目中,英國前衛生大臣和外交事務大臣、保守黨議員杰里米·亨特稱政府不取消大型集會的決定“令人意外和擔憂”,他表示根據當前的預測,英國的感染率會在約四周內達到意大利目前的水平,因此英國應該采取更極端的措施做好準備。
與此同時,前保守黨內閣大臣羅里·斯圖爾特在接受CNN主持人克里斯汀·阿曼普采訪時形容政府的決定是“非常反常的”策略,他表示英國政府的做法會帶來病毒在全世界傳播的風險,而且低估了病毒對本國衛生體系的影響。
斯圖爾特說:“英國試圖遵循群體免疫理論防控病毒。換言之,他們認為戰勝這種病毒是不可能的,所以最終不得不放任它在民眾當中傳播。”
“這是非常非常重要的選擇。但這根本不是科學選擇,而是政治上的決定。他們判斷人們準備容忍哪些限制,判斷人們準備接受學校關閉多久,這些都是經濟上的判斷。”
斯圖爾特補充說,他認為政府的判斷是錯誤的,因為政府決策過程不透明,而且“如果公眾了解到政府這種觀點隱含的意思是,他們寧愿讓一些人早死來阻止之后更多人的死亡,這時候人們會變得非常焦慮。”
杜克大學全球健康政策影響中心主任加文·亞梅發推文稱:“真是令人難以理解。瓦蘭斯怎么會知道新型冠狀病毒會變成一種季節性的、地方性流行病毒呢?瓦蘭斯怎么會知道最好的方法是有意識地希望大部分人感染病毒呢?這種風險極高的做法背后到底有什么證據??”
英國政府上周三公布的新疫情防控策略包括國家醫療服務體系將不再對醫院以外的患者進行病毒檢測,不再對輕癥患者進行檢測和確診。這條新政策讓政府更難確定人口達到群體免疫的具體時間,只能根據醫院確診新冠肺炎病例的死亡率向后推算。
貝爾法斯特女王大學實驗醫學中心呼吸道病毒感染專家林賽·布羅德本特指出,在新冠肺炎患者中輕癥患者應該占絕大多數。如果對輕癥病例不進行檢測,還會導致英國的死亡率統計數據失真。
她在推文中寫道:“對盡可能多的人進行檢測非常重要。韓國就是很好的例子。英國政府宣布僅對更嚴重的患者進行檢測,這會增加隔離感染患者的難度,并且產生英國死亡率很高的表象!”
根據世界衛生組織數據,截至3月16日,英國報告了1395例新型冠狀病毒病例,死亡病例35例。(財富中文網)
翻譯:劉進龍
審校:汪皓
The U.K. will cancel mass gatherings beginning next weekend, The Guardian newspaper reported Friday night, after a wave of high-profile cancellations and pressure from the public and scientific community appeared to force the government's hand.
The announcement came after British institutions, from football's Premier League to the Queen, moved to cancel games and official engagements, despite official government policy that cancellations would do little to stem infections and would cause too large a disruption on public life.
It also followed statements from both well-known scientists and politicians criticizing Boris Johnson's government's strategy for fighting coronavirus, which takes a markedly different approach than most European governments and, despite Friday's announcement, remains in place.
At the heart of that outcry: a policy to push for "herd immunity" to the virus, which would involve allowing at least 40 million Britons to become infected in the hopes of building up a long-term, society-wide resistance to the disease.
"Our aim is to try and reduce the peak [of the infections], broaden the peak, not suppress it completely," Patrick Vallance, chief scientific advisor to the U.K. government, told BBC Radio 4's?Today?program on Friday. "Also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission."
For herd immunity to kick in, the U.K. government said that about 60% of the population would need to contract the virus. At that point, the rate of transmissions drops enough to protect the remaining 40% of the population from contracting the virus. But the strategy is also based around trying to manage which people are in that 60%—in an ideal scenario, the government would want only those most likely to experience a mild illness to get infected. (The government has previously said, that in a worst case scenario, 80% of the population might eventually contract the virus, above the German government's estimate of 70%.)
The U.K.'s approach means many healthy people in the country have to get the disease—while keeping the fatality rate as low as possible. It's a marked break with the approach in much of the rest of the world, which is to stop people from getting coronavirus, period.
It's also an approach that is based on the assumptions that COVID-19 will be a recurring, seasonal virus—like the flu—and that once you get the virus, you can't get it again. If that's the case—and those are very big ifs—there are usually two ways to manage a virus long-term. The first is through a vaccine, and if one doesn't exist, the second is through enough people catching the virus, recovering, and being immune to re-infection, therefore making the virus much less common, and less of a risk to those who are vulnerable.
The problem is that this approach is still extremely risky, as multiple scientific experts pointed out.
"I've been talking to other academics, science journalists, private companies, & gov't people all of today and still struggling to understand this," Devi Sridhar, Chair of Global Public Health at the University of Edinburgh tweeted. "The gov't seems to be following flu playbook strategy. But this is not the flu. COVID-19 is much worse & health outcomes are sobering."
In the mean time, it's likely impossible to completely sequester those who are vulnerable or know exactly who will be vulnerable in the first place. Herd immunity is difficult; in the case of measles, for example, it's is only preserved through very high vaccination rates.
During the press conference on Thursday evening with Vallance, chief medical officer Chris Whitty, and prime minister Johnson, the government announced the country was moving to the "delay" phase for managing the virus, which includes attempting to lessen the pressure on the health system by flattening out the curve of cases and pushing the peak of the virus out to the warmer months, when respiratory viruses are typically not as viral.
That approach includes asking people with even very mild cough and flu symptoms to stay home, but stopped short of the measures seen in most other European countries and increasingly in North America, including closing schools and colleges.
The government said Thursday that it may have to impose these more stringent measures at some point in the future, but that doing so now would be premature, disrupting daily life before it was absolutely necessary, and risking the public would grow tired of complying with the restrictions and begin to ignore them just when the peak number of infections might be expected, based on the data the U.K. government has crunched.
It's a strategy that relies heavily on mathematical modeling and a government behavioral insights team, known by the nickname the "nudge unit", for their use of a psychological theory to "nudge" people towards certain behaviors—like paying their taxes, or staying home when they feel sick.
But the announced new measures, which are far less strict than those other nations' have imposed, paired with the emphasis on herd immunity, also provoked staunch criticism from both well-known virologists and epidemiologists, and politicians, including Conservatives.
On the BBC's Newsnight program, Conservative MP Jeremy Hunt, a former health secretary and foreign secretary, called the decision not to cancel large gatherings "surprising and concerning," and said that given predictions the U.K. will reach Italy's current infection rates in roughly four weeks, more extreme measures should be taken to prepare.
Meanwhile Rory Stewart, a former Conservative cabinet minister, called it a "very eccentric" tactic in an interview with CNN's Christiane Amanpour, and said the government's approach risked spreading the virus to the rest of the world, while underestimating the impact of the virus on the country's own health system.
"Britain is trying to follow a theory of herd immunity. In other words they believe it’s impossible to get on top of this disease, and therefore you have to ultimately let it run through the population," Stewart said.
"That is a very, very big choice. It’s not a scientific choice, it’s fundamentally a political choice. These are judgements about what the population are prepared to put up with, these are judgements about how long people are prepared to have schools closed, these are judgements fundamentally about economics.”
Stewart added that he thought the government had made the wrong judgement by not being transparent, and said that "when the public understands that implicit in this argument is that they would rather that people died earlier to prevent more people dying later, the public will be very troubled.”
"It is baffling," tweeted Gavin Yamey, director of the Center for Policy Impact in Global Health at Duke University. "How does Vallance *know* that this is going to be an endemic seasonal virus? How does Vallance *know* that the best approach is to deliberately hope most people get infected? Where on earth is the evidence behind this very, very risky approach??"
The announcement of the government's new strategy on Wednesday included a new policy that the NHS will stop testing for the virus outside of hospitals, leaving mild cases untested and unconfirmed. That would make it more difficult to determine when the population had indeed reached herd immunity, other than by extrapolating backwards from the fatality rate of confirmed coronavirus cases in hospitals.
But the lack of testing for mild cases, which are believed to be the vast majority, was also likely to distort the country's fatality statistics, pointed out Lindsay Broadbent, an expert on respiratory virus infections at the Centre for Experimental Medicine at Queen’s University Belfast.
"Testing as many as possible is so important. South Korea are an excellent example of this," she tweeted. "With the U.K. gov announcing they will restrict testing to more severe patients this will make isolation of infected difficult and will look like we have a high fatality rate!"
On Friday afternoon, the U.K. had 798 reported cases of coronavirus, a jump of more than 35% from the previous day, with 10 fatalities.